Making the most of the malaria vaccine

ABUJA — A new malaria vaccine now being piloted in sub-Saharan Africa, where 90 per cent of malaria cases occur, could be a game changer in global health. But, if the new vaccine is to fulfill its potential, health ministries will need to make some important changes.

Each year, malaria kills one million people worldwide, the majority of whom are children under five years of age. The economic costs of the disease in Africa, treatment expenses, absenteeism from work, foregone education, decreased productivity and loss of investment and tourism, are estimated to reach $12 billion annually.

The new RTS,S/AS01 (RTS,S) vaccine, developed by GlaxoSmithKline over 32 years at a cost of more than $700 million, could go a long way toward changing that. In clinical trials among children aged five-17 months who received four doses, the vaccine prevented approximately four in 10 – 39 per cent – cases of malaria over four years of follow-up, and about three in 10 – 29 per cent – cases of severe malaria, with significant reductions in hospital admissions. The need for blood transfusions in severe cases was cut by 29 per cent.

The first vaccine shown to provide partial protection against malaria in young children, RTS,S is now being made available through routine immunisation programmes in selected areas in Ghana, Kenya and Malawi. But while an estimated 360,000 children are expected to receive RTS,S each year, those programmes, and the health systems in which they operate, have serious weaknesses.

One weakness lies in the storage and delivery of vaccines. The potency of a vaccine dose depends on whether it has remained in a well-functioning “cold chain”, a system for storing and transporting vaccines at recommended temperatures, from the point of manufacture to the point of use. To fulfill the purpose of childhood vaccinations, the cold chains leading to children everywhere, including in remote areas, must be safeguarded and, where necessary, strengthened.

This means investing in reliable equipment for vaccine storage and transport, adequate maintenance of that equipment, personnel to manage vaccine distribution and effective monitoring of the whole system. It also means investing in infrastructure, such as roads, and, where conflict and insecurity drive up the costs of such investment, in innovative delivery mechanisms.

Zipline, a Rwandan tech firm, has pioneered the use of drones to deliver blood, vaccines, medications and other essential healthcare goods. The company, which has so far given 13 million people access to urgent treatments, recently expanded its drone delivery services to Ghana. Another tech-based solution that should be considered is the use of mobile phones to manage vaccine stocks and prevent shortages at primary healthcare facilities.

Yet another imperative for countries across Asia and Africa is to reduce their dependence on Gavi, the Vaccine Alliance, for funding vaccination programmes. Since 2001, Gavi has disbursed $893 million to Pakistan, $565 million to Nigeria and $222 million to Afghanistan, to name three examples.

Rather than continue to depend on external donors, and risk suffering the consequences of donor fatigue, countries need to take control of their vaccination programmes. One way to do that is by introducing publicly funded universal health coverage.

As it stands, millions of people in Asia and Africa lack access to adequate, affordable and reliable healthcare. Many are forced to forego life-saving health interventions, simply because they cannot cover the astronomical out-of-pocket costs.

In line with the United Nations Sustainable Development Goals, countries should be working to change this, by ensuring health coverage, including financial-risk protection and access to essential healthcare services, medicines and vaccines, for all. Instead of perpetuating vertical health programmes that focus on specific diseases, international partners should be supporting this process in the countries where they work.

Of course, even if countries fulfill all of these imperatives, the RTS,S vaccine’s efficacy is only partial. Other proven methods for preventing malaria, such as long-lasting insecticide-treated nets (LLIN), intermittent preventive therapy for pregnant women, proper sanitation and the application of residual insecticide, must be sustained and improved. For example, LLINs that are distributed to protect against malaria are often repurposed as fishing nets in Kenya, household curtains in Madagascar and protection for plant seedlings in Nigeria.

Immunisation is one of the most cost-effective public-health interventions. The RTS,S vaccine is no different, especially because it can be deployed through existing immunisation programmes. But delivering them remains a challenge in some areas. If leaders fail to meet that challenge, millions more children may not make it to their fifth birthdays.

Ifeanyi M. Nsofor, a medical doctor, is CEO of EpiAFRIC, director of Policy and Advocacy for Nigeria Health Watch, and 2019 Atlantic fellow for Health Equity at George Washington University. Project Syndicate, 2019. 
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